FLORIDA, KENTUCKY, LOUISIANA, MISSOURI AND OKLAHOMA — CareQuest Institute for Oral Health predicted that 132,572 additional children would need cavity treatments if five states banned fluoride in community water systems, according to a new analysis. The nonprofit organization estimated Medicaid costs could reach nearly $40 million within three years if Florida, Kentucky, Louisiana, Missouri and Oklahoma enacted fluoride bans.

Florida banned community water fluoridation last year, while Kentucky, Louisiana, Missouri and Oklahoma have legislation pending to ban or make optional the addition of fluoride to water systems. CareQuest Institute for Oral Health used Medicaid claims data and survey responses to predict outcomes if these five states stopped adding fluoride to water systems.

In Florida alone, 52,131 additional children beyond expected would need a cavity filled or a tooth pulled within three years of banning community water fluoridation. The analysis focused on children enrolled in Medicaid, which covers about half of U.S. children, or roughly 37 million.

Utah and Florida were the first states to ban fluoride in community water systems, with laws going into effect last year. At least 21 states have introduced bills to ban adding fluoride to community water systems.

Adding fluoride to community water systems has reduced tooth decay in the U.S. by 25%. The optimal level of fluoride in drinking water is 0.7 milligrams per liter, which is about 3 drops in a 55-gallon barrel.

"Fluoride is incorporated into the enamel, and it makes that tooth structure more resistant to acid attack, essentially making it less likely to be affected by the bacteria that causes tooth decay," said Scott Tomar, Head of the Department of Population Oral Health at the University of Illinois in Chicago. "Once they start getting their teeth, you will start to see the lack of prevention show up," Tomar said.

Jay Bhattacharya, Acting Director of the Centers for Disease Control and Prevention and Director of the National Institutes of Health, said "Fluoride is essential for oral health." He added, "The key thing is making sure the right dose is delivered in the right way."

A 2025 analysis by the National Institute of Environmental Health Sciences at the NIH found an association between higher fluoride levels in water and lower children's IQ scores. The researchers behind the 2025 NIH analysis did not suggest removing fluoride from drinking water.

Robert F. Kennedy Jr., Health and Human Services Secretary, has called fluoride "industrial waste." Dental experts in the U.S. have generally dismissed studies on fluoride's effects on children's brains because those studies were conducted in countries with much higher fluoride levels in water.